More on Expanding ADR Measurement Beyond Screening

More on Expanding ADR Measurement Beyond Screening

Douglas K. Rex, MD, MASGE, reviewing Corley DA, et al. Gastroenterology 2023 May 30.

Current recommendations suggest measuring the adenoma detection rate (ADR) in first-time screening colonoscopies. Several studies have found that including surveillance and diagnostic colonoscopies in an “overall” calculation results in values for ADR that are similar to screening ADR and classification of most physicians as high or low detectors similar to screening ADR.

This study examined the impact of including other indications for colonoscopy in the ADR calculation among 487 endoscopists who performed 1.05 million colonoscopies negative for colorectal cancer between 2011 and 2019. The mean overall ADR was 36.3%, screening ADR was 29.7%, and surveillance ADR was 48.6%. The mean ADR was 51.6% for colonoscopies with fecal immunochemical test (FIT)-positive indications, and the ADR for diagnostic examinations, excluding FIT-positive indications, was 36%.

Among providers in the lowest quartile for screening ADR, 85% remained in the lowest quartile for overall ADR. For all quartiles of ADR, 70% had identical quartile rankings for overall ADR versus screening ADR.

Douglas K. Rex, MD, FASGE


These data generally support the expansion of ADR measurement to include surveillance and diagnostic colonoscopy for indications other than FIT-positive indications. Interestingly, surveillance ADR was nearly as high as FIT-positive ADR. It looks like including surveillance ADR in the overall ADR could prevent some overall low-level performers from being recognized, perhaps those with higher percentages of surveillance cases. Expanding to overall ADR measurement could reduce “indication bias” and narrow confidence intervals around ADR measurement. For centers that extract pathology manually for ADR measurement, it will also increase workload.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Corley DA, Jensen CD, Chubak J, Schottinger JE, Halm EA, Udaltsova N; PROSPR PRECISE Consortium. Evaluating different approaches for calculating adenoma detection rate: is screening colonoscopy the gold standard? Gastroenterology 2023 May 30. (Epub ahead of print) (

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